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DSH340113BT CAROLINAS MEDICAL CENTER (Terminated)
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Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
Levine Cancer Institute / Infusion Center (0001 342800)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113BT
Medicare Provider Number
340113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/13/2015
Last Recertification Date
9/5/2018
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Atrium Health/Charlotte-Mecklenburg Hospital Authority
Ken Haynes, President and Executive Vice President
(704) 355-6305
Primary Contact
Atrium Health
Fern Paul-Aviles, Assistant Vice President, Pharmacy
(704) 649-9691
Addresses
Street Address
10826 Mallard Creek Road
Suite 100
Charlotte, NC 28262
Billing Address
Carolinas HealthCare System Accounts Payable
PO Box 5379
Portland, OR 97228-5379
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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